Top Tips for Breastfeeding with a Supplemental Nursing System

Beware! If you read to the end, you will see my nipple!

A small percentage of mums find themselves unable to exclusively breastfeed their babies. I found myself in that small percentage almost three years ago now, when B was born. I have insufficient glandular tissue and so am unable to make enough milk to keep a baby alive. It was distressing to discover, but with support I was able to breastfeed alongside supplementing. After buying a Medela supplemental nursing system and failing to get on with it, due to lack of instructions in the box and none on the internet either, I was slightly relieved when the hubby accidentally melted it whilst sterilising. We ended up using bottles with B and I would pump after every top up feed. 

This time around, I was prepared for the perils of chronic low supply. There was a supply of donor milk in the freezer and two SNSes in the cupboard. I was determined to make it work this time, knowing that with a two year old to look after, I would have very little time for the pumping required after every bottle feed. 

Our first SNS feed

An SNS is basically a bottle with thin feeding tubes attached, one of which goes in the baby's mouth along with the breast, allowing whatever supplement you are using to be drunk whilst nursing. This ensures your breasts are being stimulated to produce and enables baby to get as much of your milk as possible whilst being supplemented. SNSes can be used to induce lactation, for relactation and for supplementing a low supply. 

It is a bit tricky at first, but because I was an experienced breastfeeder this time round, I found it much easier than with B. And we're still using it 7 months later. 

So now you've got past the lengthy intro, here are my top tips for breastfeeding with an SNS - tips I wish I'd found when B was a baby:

1. Ensure baby's latch is correct before attempting to nurse with an SNS. If the latch is wrong, then you may get sore, baby won't be draining your breast effectively and they can end up sucking on the tube like a straw, rather than nursing properly. 

2. Get help with the first few feeds, until you feel a bit more confident. I had to get the hubby to hold M's hands down so that I could get my breast and the tube into her mouth at the same time, without her grabbing the tubing. 

3. Be patient. With your baby. With yourself. With the SNS. 

4. Don't screw the top on too tight - it will leak. 

5. Persevere. SNSes take practice. But when you get it, you get it. You might never love using it, but it can save your breastfeeding relationship. 

6. Resist throwing the SNS at the wall and giving up! At around 4 months babies suddenly become little monkeys when nursing. M used to pull off and shout at me. Annoying when breastfeeding normally, but when you're trying to keep a tube in their mouth it can be rage inducing! Their behaviour is perfectly normal, and not to be blamed on your low supply. Another cheeky habit they can get into is flicking the nipple out with their tongue, whilst keeping the tube in their mouth - keep a watchful eye, and remove the tube immediately. They soon give up on this little trick when they realise they'll get more milk by feeding properly. 

I found it easiest to hold the bottle

7. Keep the bottle lower than baby's mouth to prevent fast flow. I found I could only do this by holding the bottle behind M in the hand of the arm with which I was supporting her. When I wore the bottle round my neck it was either too high up or it got in the way of M's body, ruining her latch. 

8. Boiling the SNS to sterilise it can be a real pain. The hubby managed to melt the first one we bought to use for B - he forgot and the pan boiled dry. By the time we'd bought a replacement, we'd all got used to using bottles to supplement. We use Milton Sterilising Fluid to sterilise now, squeezing some of the solution through the tubes and leaving to soak for 15 minutes. This is much easier than boiling after every feed if you're using formula. If using donor/expressed milk, then washing between feeds is fine, sterilising once a day. 

9. Buy more than one SNS. Or make your own. This makes it easier to get out and about, especially if you're using formula to supplement and can't sterilise in between feeds. It also means you're not stuffed if one gets damaged. 

My attempt at a step-by-step, using a shoelace for visibility!

10. There are different ways to get the tube into baby's mouth. You can tape it to your breast so it stays in place - make sure it doesn't stick too far past the end of your nipple. You can also get baby latched on first and then sneak the tube into the side of their mouth. I didn't get on with either of those methods; I hold the tube against my nipple, flicking my finger out of the way at the last moment. Being experienced at breastfeeding certainly helped with my method because I was confident at getting M latched on properly. Try out different methods and you'll find one that works for you - one of these, or one of your own invention. It takes practice. Some great instructions here for using an SNS.

With thanks to the ladies of the IGT and Low Milk Supply Support Group for their support and advice, and for their suggestions of tips. 

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